Hospitals Report Mothers for Drug Use After Administering Medications During Childbirth

Hospitals across the United States are reporting mothers to child welfare authorities after administering medications during childbirth, only for those same substances to appear in subsequent drug tests of the mother or newborn, a joint investigation by The Marshall Project and Reveal (Center for Investigative Reporting) has found.

The issue stems from routine medications given to birthing patients, including morphine or fentanyl for pain relief, benzodiazepines for anxiety, and blood pressure medications for C-sections. These drugs can trigger positive drug test results, leading to reports to child protective services and, in some cases, the removal of children from their parents.

The investigation included interviews with two dozen patients and medical professionals, as well as a review of hundreds of pages of medical and court records. Some interviewees spoke on condition of anonymity due to the sensitive nature of child custody cases.

Victoria Villanueva, who gave birth in Indiana in 2017, experienced this firsthand. After receiving morphine for labor pain, a social worker informed her that her baby’s first bowel movement tested positive for opiates. Villanueva feared her newborn would be taken away, despite medical records showing she had no drugs in her system before the morphine was administered.

Similarly, a mother in Texas was reported to child welfare authorities after testing positive for benzodiazepine—a medication administered by hospital staff—following the stillbirth of her daughter. The hospital later reported her for illicit drug use, a claim contradicted by her medical records.

Such cases are not isolated. In New York, a mother with no history of drug use lost custody of her children for five months after testing positive for fentanyl from her epidural. In Oklahoma, a mother’s newborn and three other children were removed from her home for 11 days after testing positive for meth, only for a confirmation test to reveal the presence of a heartburn medication.

Despite well-documented evidence that medications can cause positive drug test results, many hospitals lack policies requiring providers to review a patient’s records before reporting them. A 2022 study found that 91 percent of women given fentanyl in their epidurals tested positive for it afterward. Experts emphasize that a baby’s positive drug test "cannot and should not be used to identify fentanyl drug abuse in mothers."

Hospital policies vary. Some facilities require automatic reporting of positive tests, while others perform assessments first. However, social workers, who often handle these reports, are frequently overworked, increasing the risk of errors.

Dr. Davida Schiff, whose hospital network, Mass General Brigham in New England, recently implemented a new policy to address these issues, stated, "The hospitals are at fault. The clinicians are at fault. Our policies are at fault." The new policy directs providers to drug test patients only when medically necessary and halts automatic reporting of positive results.

Federal law requires hospitals to alert child welfare agencies when babies are born with substances that may cause withdrawal symptoms. However, the inexpensive urine tests used by many hospitals are prone to false positives and errors. Many hospitals have failed to implement safeguards to prevent patients from being wrongly reported.

Dr. Tricia Wright, an OB-GYN and professor at the University of California, San Francisco Medical Center, noted that interpreting drug test results is not routinely taught in medical training. She helped change her hospital’s policy in 2021 to drug test patients only when medically necessary.

While drug tests can aid in treating infants experiencing withdrawal, many OB-GYNs say positive results do not typically inform the mother’s medical care, making routine testing unnecessary. Instead, the responsibility often falls to social workers, who may be overburdened and lack the time to thoroughly review each case.

The investigation highlights the need for hospitals to adopt more careful and medically informed approaches to drug testing and reporting, ensuring that mothers and newborns are not unfairly penalized for necessary medical treatments.